Patient Care and Monitoring

1. Identify the underlying cause of the nausea and vomiting and eliminate it if possible. Counsel the patient to avoid known triggers.

2. Assess the patient to determine whether the nausea and vomiting is simple or complex and whether patient-directed therapy is appropriate.

3. Obtain a thorough patient history including the prescription, nonprescription, and herbal medications being used. Identify any substances that may be causing or worsening nausea and vomiting. Determine which treatments for nausea and vomiting have been used in the past and their degree of efficacy.

4. Develop a treatment plan with the patient and other health care professionals if appropriate. Choose therapeutic options based on the underlying cause of nausea and vomiting, duration and severity of symptoms, comorbid conditions, medication allergies, presence of contraindications, risk of drug-drug interactions, and treatment adverse-effect profiles.

5. Use the oral route of administration if the patient has mild nausea with minimal or no vomiting. Seek an alternative route (e.g., transdermal, rectal suppository, or parenteral) if the patient is unable to retain oral medications due to vomiting.

6. Educate the patient about nonpharmacologic measures such as stimulus avoidance, dietary changes, acupressure or acupuncture, and psychotherapy.

7. To assess efficacy, ask the patient whether he or she is still experiencing nausea or vomiting while using the therapy. Assess whether treatment failure is due to inappropriate medication use or the need for additional or different treatments and proceed accordingly.

8. Assess adverse effects by asking the patient what he or she has experienced. Also, patient observation or examination is useful for diagnosing adverse effects such as EPS.

9. Provide patient education regarding causes of nausea and vomiting, avoidance of triggers, potential complications, therapeutic options, medication adverse effects, and when to seek medical attention.

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